How many more people have to die before we get serious about treating mental illness in this country? The latest reports on Navy Yard mass killer Aaron Alexis, a New Yorker who spent time in Fort Worth, shows that the 34-year-old who killed a dozen people Monday suffered from paranoid schizophrenia. Sounds familiar? That’s the same diagnosis for alleged Aurora, Colorado shooter James Holmes, whom I wrote about all too recently. John Zawahri, the young man in Santa Monica who shot and killed four people before being shot and killed by police, had mental health issues, too.

So did Adam Lanza in Newtown, Conn., Jared Loughner in Tucson, Ariz., Seung-Hui Cho at Virginia Tech in Blacksburg, Va., John Hinckley Jr. (who once lived in the Park Cities) who shot at President Ronald Reagan (and is still institutionalized for insanity), Mark David Chapman (who was born in Fort Worth), who killed John Lennon (and while clearly delusional is in prison rather than a mental facility).

We keep writing the story where we decry the tragedy, with some of us getting angry at the killer. But what do we do to change it? Nothing. The Treatment Advocacy Center, a national non-profit organization based in Arlington, Va., reports that mental illness is a factor in an estimated 50% of rampage killings and 10% of all homicides since the wholesale closure of public psychiatric hospitals. That movement escalated in 1981 after President Ronald Reagan’s Omnibus Budget Reconciliation Act repealed President Jimmy Carter’s community health legislation, Mother Jones reported in an April story called Deinstitutionalization and Its Consequences. President Reagan ended the federal government’s role in providing services to the mentally ill, moving instead to block grants for the states, too many of which have done a woeful job of making up the difference.

James Holmes suffers from schizophrenia

Today, the nation has 5% the number of public psychiatric beds that existed in the late 1950s and exponentially more mass homicides, according to Doris A. Fuller, executive director of the Treatment Advocacy Center. The numbers the center provides are chilling: Only one mass killing occurred in the 1940s, compared to 73 in the 1990s.

There are a lot more people out there with mental illness than most of us realize. The Treatment Advocacy Center estimates that approximately 7.7 million American adults suffer from severe bipolar disorder or schizophrenia and about 3.6 million of those adults are untreated in any given year, with substantial numbers ending up homeless, in jails or prisons, completing suicide, committing acts of violence or being victimized.

Contributing to the problem is a lack of recognition of the signs and not enough understanding of the solutions. Too many people still believe you can talk people out of their delusions and anxieties without the benefit of professional intervention and medication.

Plus, about 40% of people with bipolar disorder and 50% of people with schizophrenia do not themselves know that they are mentally ill and so will not seek the help they need themselves, Fuller says.

Texas law offers a way to report those who are mentally ill. According to the Treatment Advocacy Center website, Texas dictates that a peace officer, without a warrant, may take a person into custody if the officer: (1) has reason to believe and does believe that: (A) the person is mentally ill; and (B) because of that mental illness there is a substantial risk of serious harm to the person or to others unless the person is immediately restrained.

But where does that person go if he is mentally ill when there are too few beds? Who pays for that person’s care if they don’t have health insurance?

Texas is 49th in mental health spending, which is nothing to be proud of. You can get more details on this in Christina Rosales’ excellent story about mental health advocates pointing out that more Texans with mental illness are in jails and prisons than in hospitals. You can read even more on the Dallas Morning News splash page on mental health: Erasing the Stigma. And you can shake your head in utter exasperation at why Texas turned down the Medicaid expansion that would have helped so many of the mentally ill who are living right now on the edge.

Yes, we keep writing sad stories and acting as if all this is inevitable. It is not inevitable. There are things that had been done to help the mentally ill in the past and could be done again. What I want to know is how many stories must be written before people rise up and demand government take care of the mentally ill before the next tragedy strikes? What will it take to win the fight to help our vulnerable and their victims?

Los Angeles Police Department officers along with Los Angeles County Sheriff deputies search the campus of Santa Monica College after a reported shooting on Friday, June 7.

John Zawahri, the young man in Santa Monica who shot and killed four people before being shot and killed by police, had mental issues, according to a report by cnn.com.

His rampage was Friday. He would have been 24 on Saturday. We don’t yet know what his diagnosis was, but it was related to his threat to harm someone. CNN also reported that the police had police had contact with him in 2006, but can’t release further information because he was a juvenile then.

RJ Sangosti/AP James Eagan Holmes faces two first-degree murder charges for each of the 12 people killed and two attempted first-degree murder charges for every one of the 58 injured in the July 20 shooting.

And so the questions that followed the shootings by James Holmes in Aurora, Colo. Adam Lanza in Newtown, Conn. in 2012 and Jared Loughner in Tucson, Ariz. and 2011, must be asked again. How did someone with a history of mental illness get access to guns? Why didn’t someone with a history of mental illness get the help he needed? And why isn’t there some way to keep tabs on troubled young men as they age out of college and into the danger zone of their early to mid-twenties, when certain psychiatric diseases such as schizophrenia become manifest?

Many parents of kids with special needs lament that society has a way of forgetting about their children once they exit the public school system. All of a sudden, the structure, the support for those who can’t make it on their own is not there. The parents are left to scramble for ways to help their children navigate a bewildering world.

That problem is compounded for parents of kids with mental illnesses who may be dangerous to themselves and others. Again and again it seems the violence is committed by young men who couldn’t find a foothold in schools or the workplace and don’t know what to do with themselves: Adam Lanza, 20; James Holmes, 25; Jared Loughner, 24 and now John Zawahri, 23. And then there are those of a certain age that precede them.

Lee Harvey Oswald

Seung-Hui Cho, was 23, when he killed 32 and wounded 17 at Virginia Tech in Blacksburg, Va. Lee Harvey Oswald was 24 when he was arrested for the assassination of President John F. Kennedy (Oswald died before we could learn the extent of his mental problems). John Hinckley Jr. (who once lived in the Park Cities) who was 25 when he shot at President Ronald Reagan (and is still institutionalized for insanity). Mark David Chapman (who was born in Fort Worth) was 25 when he killed John Lennon (and while clearly delusional is in prison rather than a mental facility).

I’ve written before about how Texas is 49th in mental health spending, which is nothing to be proud of. You can get more details on this in Christina Rosales’ excellent story about mental health advocates pointing out that more Texans with mental illness are in jails and prisons than in hospitals. Rosales quotes data from the National Alliance on Mental Illness, Dallas, that points out that it costs 11 times more to treat people with mental illness in jails than in the community.

But the sad truth is that the other states don’t seem to have any clue as to what to do about recognizing and treating schizophrenia and other mental illnesses before tragedy strikes. One of the problems with schizophrenia in particular is that its onset usually coincides with when someone has outgrown the public school system and is in a no-man’s land of anyone’s responsibility. This disease, where a person can’t distinguish reality from paranoid fantasies, impedes a person’s ability to succeed at a job or at college, which are the next steps after high school. An inability to find a foothold usually leaves that person without access to the health insurance that they desperately need to regain a foothold or a chance at a productive or stable life. It’s a Catch-22 that leaves them spiralling ever further out of control.

In Texas, to qualify for Medicaid and get the treatment and medication you would need to stabilize a mental condition, you have to show that its onset occurred while the person is under 18 and still a minor. Well, guess what? In most cases, the condition doesn’t occur until significantly past that age, so what do those people do then?

I hope there will be many conversations about guns and mental health. At the same time, I think we need to open up a new question about schizophrenia and other mental illnesses, including bipolar disorder, that may not manifest itself someone is in his or her twenties.

The Treatment Advocacy Center, a national non-profit organization based in Arlington, Va. that was founded in 1998, estimates that approximately 7.7 million American adults suffer from severe bipolar disorder or schizophrenia and about 3.6 million of those adults are untreated in any given year, with substantial numbers ending up homeless, in jails or prisons, completing suicide, committing acts of violence or being victimized.

It doesn’t help that about 40% of people with bipolar disorder and 50% of people with schizophrenia do not themselves know that they are mentally ill and so will not seek the help they need themselves.

I don’t know how we would start going about keeping tabs on those who are mentally ill as they leave high school. Should it be required that when someone has treatment for a mental illness as a minor, as many of the young men in these cases did, there should be check-ups required at regular intervals? Should we educate our youth and general public to be as aware of the signs of mental illness as we try to be vigilant about learning CPR in case of a physical emergency? Do we need to have a better and more user-friendly system in place for what people should do if they spot the signs and how people can access help if needed?

Here’s a troubling piece of information from the Treatment Advocacy Center: the increasing lack of public psychiatric beds may inhibit our ability to act decisively when we suspect there’s trouble. Texas has only 8.5 beds per 100,000 people after cutting 22% of its total public psychiatric beds between 2005-2010.

Of course, mentally ill people cannot stay in psychiatric facilities indefinitely. The problem also calls for a look at more group homes that are well regulated where a caretaker can ensure that medications are being taken correctly and working well.

We can punish those who commit crimes, but the mentally ill are not deterred by how we punish others. Their minds are not wired to think in terms of cause and effect. We need to understand their minds better and take steps to help them become less of a danger to others and to themselves before the next tragedy strikes.

Did you know that Idaho is the only state that spends less on mental health spending than Texas? Yes, that’s right. Texas ranks 49th in mental health spending, which is something I learned in Christina Rosales’ excellent story today, Mental health advocates urge more state funding. In Rosales’ story, Ron Stretcher, director of the county’s Criminal Justice Department, said more Texans with mental illness are in jails and prisons than in hospitals; she then referred to data from the National Alliance on Mental Illness, Dallas, that points out that it costs 11 times more to treat people with mental illness in jails than in the community.

So if Texas isn’t moved by the mounting tragedies of mass killings by the mentally ilI like James Holmes and Jared Loughner, both of whom have been diagnosed with schizophrenia (we’re still waiting for the report of the clearly troubled Adam Lanza in the Sandy Hook shootings), maybe crunching the financial numbers will do the trick. When it does, the next question is what would be the best way to spend any additional funds?

I hope that in addition to the obvious — making medications and case managers available to those with mental illness, attention will be paid to the desperate need for more hospital beds for those needing temporary institutionalization and safe, well-run group homes for those needing long term care. Often the mentally ill live at home because they can’t take care of themselves. (Don’t get me started on those like James Holmes who were living alone with mental illness — that, I think, is really crazy). I applaud the parents that can provide the care their children need, but it can become increasingly difficult for the best parents to force their adult children to take their medication and what happens to those children when the parents become infirm themselves or pass away?

When I wrote earlier about Holmes, I talked about The Treatment Advocacy Center, a national non-profit organization based in Arlington, Va. that estimates that approximately 7.7 million American adults suffer from severe bipolar disorder or schizophrenia and about 3.6 million of those adults are untreated in any given year, with substantial numbers ending up homeless, in jails or prisons, completing suicide, committing acts of violence or being victimized.

About 40% of people with bipolar disorder and 50% of people with schizophrenia do not themselves know that they are mentally ill and so will not seek the help they need themselves, says Doris Fuller, executive director of The Treatment Advocacy Center.

Texas law offers a way for those who are mentally ill to be reported. According to the Treatment Advocacy Center website, Texas dictates that a peace officer, without a warrant, may take a person into custody if the officer: (1) has reason to believe and does believe that: (A) the person is mentally ill; and (B) because of that mental illness there is a substantial risk of serious harm to the person or to others unless the person is immediately restrained.

In Texas, a written application for the emergency detention of another person …must state: (1) that the applicant has reason to believe and does believe that the person evidences mental illness; (2) that the applicant has reason to believe and does believe that the person evidences a substantial risk of serious harm to himself or others; (3) a specific description of the risk of harm; (4) that the applicant has reason to believe and does believe that the risk of harm is imminent unless the person is immediately restrained; (5) that the applicant’s beliefs are derived from specific recent behavior, overt acts, attempts, or threats (6) a detailed description of the specific behavior, acts, attempts, or threats; and (7) a detailed description of the applicant’s relationship to the person whose detention is sought.

But where would those people that are reported go? Texas has only 8.5 beds for psychiatric patients available per 100,000 people after cutting 22% of its total public psychiatric beds between 2005-2010.

As I wrote before, we all know the importance of learning the signs of heart attack and stroke and how to do CPR to save lives, but shouldn’t we know the signs of mental illness which, untreated, can cause fatalities?

Even if you don’t know someone in your life who suffers from something awry in the brain (and chances are you may know someone without realizing it), the life you save, when you save anyone who is mentally ill, could be your own — or that of someone you love.

In the heat of the discussion of the tragic killings at Sandy Hook Elementary (and so many more before it), one mom shared with me her frustration about gun control laws as it pertained to her own mentally ill child.

Her son asked if he could put himself on a “no-sell” list so that no one could sell a firearm to him the next time he had a psychotic break and had lost touch with reality. She found that no such voluntary “no-sell” list exists. To get on such a list you would have already had to commit a crime by which time it is too late. And even then, it turns out, even AFTER committing a crime, you can appeal to be able to buy a gun again.

So what is this mom or any other parent of a mentally ill person to do? In contrast with Nancy Lanza, the mother of the 20-year-old shooter Adam Lanza, she has done her best to keep guns away from her child. She does not have them in the house. But the world is a big place. Can’t we help her help her son? Can’t we help her son help himself?

Josh Hurwitz at the Huffington Post wrote an eye-opening piece in the wake of the Aurora, Colorado shooting by the mentally ill James Holmes: Aurora’s hard truth: mental health screening for gun buyers is virtually non-existent. As Hurwitz points out, Americans can buy firearms through private sales in more than 40 states without any screenings. Even the places that put restrictions on the mentally ill purchasing firearms do it for very few and even then only temporarily. For instance, you cannot get a firearm if you have been involuntarily committed to a mental institution by a court or other lawful authority (something which doesn’t even happen to most people with bipolar disorder or schizophrenia), but if you went into the mental institution voluntarily, you don’t even have to wait.

Plus, while being committed involuntarily used to preclude a gun purchase for life, federal laws have procedures that allow individuals to restore their right to purchase or possess guns. And yes, we’re talking about felons, too; they can go through a procedure to regain their right to buy guns with chilling results as this New York Times story from last year demonstrates.

James Holmes was under the care of a psychiatrist who specialized in schizophrenia before he shot and killed so many in that Aurora, Co. movie theater this summer and Jared Loughner, who killed six and wounded 12 others including former Rep. Gabrielle Giffords in Tucson, Ariz. last year, was determined by the court to have paranoid schizophrenia. Neither had a problem purchasing guns.

Hurwitz notes that it’s been almost 45 years since federal legislators defined mental health disqualifications for gun buyers in the Gun Control Act of 1968. If we can revisit the USDA standards to get healthier lunches in our schools as we did this year, making the first changes in 15 years, surely we can revisit the Gun Control Act of 1968 to make our schools safer places for our kids to be.

Residents of Newtown, Connecticut comforted each other at an interfaith vigil Sunday.

Much has been made of Adam Lanza, the 20-year-old shooter at Sandy Hook Elementary School in Newtown, Conn., who took so many innocent lives, as having Asperger Syndrome, a high functioning condition on the autism spectrum which has recently been reclassified as autism. Experts and parents who have children with Asperger Syndrome want everyone to know that there is no correlation between autism and violence and express concern that autism is a developmental disorder and NOT a mental illness. Parents of those with autism, who are already too often stigmatized in our society, are worried that this will lead to their kids being further shunned and misunderstood.

According to a Friday statement by the Autistic Self Advocacy Network: “Recent media reports have suggested that the perpetrator of this violence, Adam Lanza, may have been diagnosed with Asperger’s Syndrome, a diagnosis on the autism spectrum, or with another psychiatric disability. In either event, it is imperative that as we mourn the victims of this horrific tragedy that commentators and the media avoid drawing inappropriate and unfounded links between autism or other disabilities and violence. Autistic Americans and individuals with other disabilities are no more likely to commit violent crime than non-disabled people. In fact, people with disabilities of all kinds, including autism, are vastly more likely to be the victims of violent crime than the perpetrators. Should the shooter in today’s shooting prove to in fact be diagnosed on the autism spectrum or with another disability, the millions of Americans with disabilities should be no more implicated in his actions than the non-disabled population is responsible for those of non-disabled shooters.”

Dan Burns with his son, Ben, who has autism. Ben, Dan told me, changed him from a human 'doing' into a human being

Just today, I touched base with a local mom, Vicki L. Hill, who has an adult son with autism, who is thriving within a supportive network. She had this to share:

“In light of the recent tragedy in Newtown, CT, many are people are asking, “Why? What could drive a person to do something like this?” We will never truly know the answers in this particular case, given that both the shooter and his mother are now dead. But we do have some clues as to what is – and is not – involved.

The shooter’s brother identified him as being diagnosed with Asperger Syndrome. Asperger is a developmental disorder which involves impairment in social interaction as well as restricted patterns of behavior and interest. It is not at all associated with violence. The typical person with Asperger Syndrome may have difficulty with eye contact or with the typical ebb and flow of casual conversation. Some may have special interests – for example, a history buff who manages to steer every conversation back to a discussion of the Civil War, or a sports fan who knows the statistics from every game the Mavericks ever played.

The shooter’s brother also suggested that his brother may have had at least one other diagnosis which was psychiatric in nature. While the brother wasn’t as clear as to the exact diagnosis, we know that the vast majority of people with psychiatric disorders also are not violent. In fact, they are far more likely to be the victims of violence than the perpetrators. Psychiatric disorders are disorders of the brain.

Sometimes developmental disorders and psychiatric disorders overlap, as appears to have occurred in this case. But, that, too, is not associated with violence.

So what could have driven this shooter to take these actions? Some brain disorders can include episodes where the person loses touch with reality. The person can experience delusions or hallucinations. While these symptoms are treatable with medication in psychiatric patients, the very nature of these symptoms sometimes cause the person to be unaware that he is experiencing these symptoms. Think of the person with Alzheimer’s who is convinced that the year is 1972. The brain disorder itself is causing the distorted thinking. Not every episode of delusion is connected with violence, but nearly every episode of violence caused by a person with mental illness is connected to delusional thinking.

Was the shooter getting psychiatric help? We don’t know the answer to that yet. But we do know that a friend of the mother has commented that she was fearful in the days before the horrifying shooting. “She said it was getting worse. She was having trouble reaching him,” said a friend of Mrs Lanza….” [The Telegraph] Why didn’t she simply call authorities or have him hospitalized? It isn’t that simple. The shooter was 20 years old – an adult. While an observant mother could see that the situation was deteriorating, the nature of the disorder could have meant that the 20 year old didn’t see it himself. And without his permission, she was powerless to get him help. Our laws do not permit the family of an adult with a psychiatric disorder to insist on treatment or hospitalization in such cases. Only when the risk of harm to the person or to others is clear to a judge can the person be held against his will. Far too often, that risk only becomes clear after a crime has been committed.

No, Asperger Syndrome did not cause this action. A disorder causing the shooter to lose touch with reality is most likely to be behind this. Mix that with restrictive rules on intervention, as well as his access to weapons, and an individual crisis turned into a national tragedy.”

My heart goes out to all those who lost loved ones in the horrific shooting at a Connecticut elementary school today. The latest word is that the shooter, who died of a self-inflicted gunshot wound, was 20-year-old Adam Lanza (mistakenly identified at first as his brother 24-year-old Ryan Lanza). I am thinking about Lee Harvey Oswald who was 24 when he was arrested for the assassination of President John F. Kennedy (Oswald died before we could learn the extent of his mental problems), John Hinckley Jr. (who once lived in the Park Cities) who was 25 when he shot at President Ronald Reagan (and is still institutionalized for insanity) and Mark David Chapman (who was born in Fort Worth) and was 25 when he killed John Lennon (and while clearly delusional is in prison rather than a mental facility). Now I’m waiting to hear if this tragedy has anything to do with mental illness, and particularly bipolar disease or schizophrenia which seems to rear its head in the early 20s.

It seems as if I was just writing about James Holmes, the young man with schizophrenia who was 24 when he killed 12 people, including a 6-year-old girl, with as many as 59 more wounded at a screening of the new Batman film,The Dark Knight Rises at a Colorado theater. And here we are again, mourning innocents lost and not doing anything to address what happens when weapons of mass destruction, and I do consider 27 deaths (including 20 children) mass destruction, fall into the wrong hands.

Some people may see this as a time to lobby for limitations on gun ownership as was done in the wake of the Hinckley shooting. My personal feeling? I hope they do. I think when a lot of people argue for the recall of any restrictions based on second amendment “rights,” they’re usually being whipped up into hysteria by gun manufacturers whose only real concern is losing some money over fewer gun sales. Doesn’t anyone wonder why a 20-year-old needs to have access to firearms? Isn’t it interesting that most major car rental companies refuse to rent a car to someone who is under 21 and in some cases 25? Do you know why? Because they know what scientists know — that at those ages the frontal lobes are not fully developed and judgment and impulse control are still maturing as Dr. Sandra Chapman of the Center for BrainHealth at UT Dallas told me for my story on the brain.

Anyone see any irony in that no one would rent a car to a 20-year-old kid but if he wants a gun, no problem? Maybe that’s because the gun companies don’t pay a price for these shootings, but the rental companies lose money when a kid has an accident.

I know this is premature in this case, but my biggest concern now is our lack of understanding and treatment of mental illness which returns to haunt us again and again. As I wrote in my piece about James Holmes, The Treatment Advocacy Center, a national non-profit organization based in Arlington, Va. that was founded in 1998, estimates that approximately 7.7 million American adults suffer from severe bipolar disorder or schizophrenia and about 3.6 million of those adults are untreated in any given year, with substantial numbers ending up homeless, in jails or prisons, completing suicide, committing acts of violence or being victimized. It doesn’t help that about 40% of people with bipolar disorder and 50% of people with schizophrenia do not themselves know that they are mentally ill and so will not seek the help they need themselves.

We have all got to do better in understanding, treating and most of all preventing the ravages of mental illness. We need to do it for our children’s sake. Each and every death hurts too much.